Cervicothoracic Manual Therapy Plus Exercise Therapy Versus Exercise Therapy Alone in the Management of Individuals With Shoulder Pain: A Multicenter Randomized Controlled Trial

Abstract

Study Design Multicenter randomized controlled trial. Background Cervicothoracic manual therapy has been shown to improve pain and disability in individuals with shoulder pain, but the incremental effects of manual therapy in addition to exercise therapy have not been investigated in a randomized controlled trial. Objectives To compare the effects of cervicothoracic manual therapy and exercise therapy to those of exercise therapy alone in individuals with shoulder pain. Methods Individuals (n = 140) with shoulder pain were randomly assigned to receive 2 sessions of cervicothoracic range-of-motion exercises plus 6 sessions of exercise therapy, or 2 sessions of high-dose cervicothoracic manual therapy and range-of-motion exercises plus 6 sessions of exercise therapy (manual therapy plus exercise). Pain and disability were assessed at baseline, 1 week, 4 weeks, and 6 months. The primary aim (treatment group by time) was examined using linear mixed-model analyses and the repeated measure of time for the Shoulder Pain and Disability Index (SPADI), the numeric pain-rating scale, and the shortened version of the Disabilities of the Arm, Shoulder and Hand questionnaire (QuickDASH). Patient-perceived success was assessed and analyzed using the global rating of change (GROC) and the Patient Acceptable Symptom State (PASS), using chi-square tests of independence. Results There were no significant 2-way interactions of group by time or main effects by group for pain or disability. Both groups improved significantly on the SPADI, numeric pain-rating scale, and QuickDASH. Secondary outcomes of success on the GROC and PASS significantly favored the manual therapy-plus-exercise group at 4 weeks (P = .03 and P<.01, respectively) and on the GROC at 6 months (P = .04). Conclusion Adding 2 sessions of high-dose cervicothoracic manual therapy to an exercise program did not improve pain or disability in patients with shoulder pain, but did improve patient-perceived success at 4 weeks and 6 months and acceptability of symptoms at 4 weeks. More research is needed on the use of cervicothoracic manual therapy for treating shoulder pain. Level of Evidence Therapy, level 1b. Prospectively registered March 30, 2012 at www.ClinicalTrials.gov (NCT01571674). J Orthop Sports Phys Ther 2016;46(8):617-628. doi:10.2519/jospt.2016.6319.

The added value of therapist communication on the effect of physical therapy treatment in older adults; a systematic review and meta-analysis

“…These findings are in line with those from other studies that measured the effect of other additional interventions (e.g. manipulation) beyond exercise [53,54]. The only effect on physical activity levels was in self-reported physical activity outcomes and not in performance-based measures.…”

Measures of Adult Shoulder Function

“…The SPADI had been used in almost 50 randomized controlled trials of interventions for various shoulder disorders through the end of 2015 (2). Recent examples include trials of therapeutic deep heat for shoulder pain (46), exercise versus physical therapy for rotator cuff disease (47), cervicothoracic manual therapy (48), glucocorticoid injections for shoulder pain (49), intra‐articular hyaluronate and tramadol injections for adhesive capsulitis (50), and extracorporeal shockwave therapy for shoulder pain (51). In some cases in which the SPADI was used as an outcome measure for trials performed in countries where English is not the primary language, validated translations were used (51), but in many cases it was unclear whether this was the case (46,50).…”

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